Kudos for this lucid article, Awais! In my view, one of the most important sections is this excerpt:
"It is often said that psychiatric diagnoses don’t explain anything, though this is not quite true. They do offer a limited form of explanation, namely that of pattern recognition and matching. When a diagnosis is made, the clinician is conveying to the patient that their presentation matches this well-recognised pattern of symptoms, and not these other patterns that could conceivably apply. Based on that, we can link the person’s presentation with existing medical knowledge and use treatments that have been studied for that pattern. This is why accurate diagnoses of conditions such as autism and ADHD can offer powerful explanations for patients and lead them to look at their lives in a new light, even though the causes and mechanisms remain unknown."
This is precisely the point Dr. Mark Ruffalo have been making in our numerous debates with two Finnish colleagues, published in Psychiatric Times. For example, we wrote:
"...when we provide the patient with a psychiatric diagnosis, we are simply hypothesizing the existence of a condition that “best makes sense” of the patient’s presenting signs and symptoms. This is very close to what philosophers of science call “inference to the best explanation.” In so doing, we are not making any metaphysical claims, or reifying the condition by positing some essence, substance, or thing residing inside the patient—akin to, say, a burst appendix."
I encourage readers to read the entire article on Psyche. For reasons unclear to me, I got five times more out of the complete article than I got out of the extract.
Great piece (inc. the full piece on 'Psyche')! Does your reference to diagnoses' 'cause distress or impairment' reflect the construct of 'dysfunction'? I'm curious if those constructs overlap at all, and if distress is necessary (e.g. the HDA definition) or if the phenomenological experience of the symptoms alone without distress/harm (whilst acknowledging non-symptomatic criteria onset/duration/differentials etc) warrant a diagnosis.
Ah! This was one of the things that got taken out of the Psyche piece by the editor due to the word limit. I’ll put it in part 2, but to address your question, this is what that part of the text said:
“A diagnosis is the clinical recognition of a problem
The idea of “disorder” as it is used in the diagnostic manuals is a rather common-sensical one. It is centered on practical considerations of harm (distress, disability, impairment in functioning, disruption in one’s life, etc.) and practical judgments that something has gone wrong: that the individual is experiencing a state that is out of the ordinary, that violates our usual expectations of what is typical, rational, meaningful, proportional, or understandable within a context. Disorder does not refer to the identification of a discrete disease entity or a “chemical imbalance.” Calling a problem a disorder does not mean that the causes are only or even predominantly within a person. There is considerable philosophical and scientific controversy around how the notion of “disorder” ought to be properly understood in medicine and psychology. Some philosophers and professionals take the view that in order for something to be called a disorder, the condition must involve the breakdown of a biological mechanism to perform its natural function. However, most clinicians work with a broad and flexible notion of disorder that relies on clinical and practical judgements of abnormality and harm. For those who wish to avoid the conceptual baggage that comes with the term “disorder,” “mental health problem” is a reasonable substitute.”
Kudos for this lucid article, Awais! In my view, one of the most important sections is this excerpt:
"It is often said that psychiatric diagnoses don’t explain anything, though this is not quite true. They do offer a limited form of explanation, namely that of pattern recognition and matching. When a diagnosis is made, the clinician is conveying to the patient that their presentation matches this well-recognised pattern of symptoms, and not these other patterns that could conceivably apply. Based on that, we can link the person’s presentation with existing medical knowledge and use treatments that have been studied for that pattern. This is why accurate diagnoses of conditions such as autism and ADHD can offer powerful explanations for patients and lead them to look at their lives in a new light, even though the causes and mechanisms remain unknown."
This is precisely the point Dr. Mark Ruffalo have been making in our numerous debates with two Finnish colleagues, published in Psychiatric Times. For example, we wrote:
"...when we provide the patient with a psychiatric diagnosis, we are simply hypothesizing the existence of a condition that “best makes sense” of the patient’s presenting signs and symptoms. This is very close to what philosophers of science call “inference to the best explanation.” In so doing, we are not making any metaphysical claims, or reifying the condition by positing some essence, substance, or thing residing inside the patient—akin to, say, a burst appendix."
https://www.psychiatrictimes.com/view/no-psychiatric-diagnoses-do-not-reflect-circular-logic
Thanks again for your efforts in bringing these ideas to a wide, general audience.
Regards,
Ron
Ronald W. Pies MD
Also see: https://www.psychiatrictimes.com/view/our-closing-argument-in-defense-of-psychiatric-diagnosis
I encourage readers to read the entire article on Psyche. For reasons unclear to me, I got five times more out of the complete article than I got out of the extract.
I do hope readers will read the whole thing!
Great piece (inc. the full piece on 'Psyche')! Does your reference to diagnoses' 'cause distress or impairment' reflect the construct of 'dysfunction'? I'm curious if those constructs overlap at all, and if distress is necessary (e.g. the HDA definition) or if the phenomenological experience of the symptoms alone without distress/harm (whilst acknowledging non-symptomatic criteria onset/duration/differentials etc) warrant a diagnosis.
Ah! This was one of the things that got taken out of the Psyche piece by the editor due to the word limit. I’ll put it in part 2, but to address your question, this is what that part of the text said:
“A diagnosis is the clinical recognition of a problem
The idea of “disorder” as it is used in the diagnostic manuals is a rather common-sensical one. It is centered on practical considerations of harm (distress, disability, impairment in functioning, disruption in one’s life, etc.) and practical judgments that something has gone wrong: that the individual is experiencing a state that is out of the ordinary, that violates our usual expectations of what is typical, rational, meaningful, proportional, or understandable within a context. Disorder does not refer to the identification of a discrete disease entity or a “chemical imbalance.” Calling a problem a disorder does not mean that the causes are only or even predominantly within a person. There is considerable philosophical and scientific controversy around how the notion of “disorder” ought to be properly understood in medicine and psychology. Some philosophers and professionals take the view that in order for something to be called a disorder, the condition must involve the breakdown of a biological mechanism to perform its natural function. However, most clinicians work with a broad and flexible notion of disorder that relies on clinical and practical judgements of abnormality and harm. For those who wish to avoid the conceptual baggage that comes with the term “disorder,” “mental health problem” is a reasonable substitute.”